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CENTER OF GRAVITY Does the Center of Gravity lie in front of or behind the Hip Joint? o It lies behind the hip joint, which tends to extend the hip. What ligament prevents further extension of hip joint (due to the Center of Gravity) by passively supporting the weight of the trunk? o Iliofemoral Ligament What group of muscles adds support by flanking the vertebral column and allowing movements to correct trunk and pelvic girdle balance? o Paraspinal Muscles What muscle of the leg further supports the Center of Gravity? o Tibialis Anterior pulls the Tibia Anteriorly to balance the Center of Gravity What ligament supports joints against Lateral Movements in the Hip and Thigh Region? o Tensor Fascia Latae and IT Band What ligament supports joints against Lateral Movements in the Knee Region? o Fibulocollateral Ligament (LCL) Where does the Fibulocollateral Ligament (LCL) originate and insert? o Originate: Lateral Condyle of the Femur o Insert: Head of the Fibula THE GLUTEAL REGION What are the three bones of the hip? o Ischium o Ilium o Pubis What is the junction of the three hipbones called? o Acetabulum What are the two ligaments of the Greater and Lesser Sciatic Notch? o Sacrotuberous Ligament o Sacrospinous Ligament What passes through the Pudendal (Alcock’s) Canal? o Internal Pudendal Artery o Internal Pudendal Vein o Pudendal Nerve Where does the Fibrous Joint Capsule of the Hip Joint attach to the Femur? o Intertrochanteric Line (Anterior) What type of joint is the Hip Joint? o Synovial Joint What is the Articular Surface of the Acetabulum called? o Lunate Surface What type of cartilage lines the Hip Joint? o Hyaline What is the Ligamentum Teres? o Ligament of the Head of the Femur Where does the Ligament of the Head of the Femur originate? o The Acetabular Notch and the Transverse Ligament What travels inside of the ligament of the Head of the Femur? What larger artery gives off this branch? o Artery to the Head of the Femur o Obturator Artery Where do all of the ligaments that stabilize the hip joint originate and insert from? o The Pelvic Bone to the Femur What is the most important ligament of the Hip Joint? o Iliofemoral (Anterior) What are the Posterior and Inferior Ligaments of the Hip Joint? o Posterior: Ischiofemoral Ligament o Inferior: Pubofemoral Ligament What is the Zona Orbicularis? o Forms a locking ring around the neck of the femur to stabilize the hip. What do the blood vessels travel through to get to the head and neck of the femur? o Retinacula – capsular fibers that reflect back to add for protection. What position is most vulnerable for dislocation of the Hip Joint? o Flexed and Adducted (sitting with thighs crossed) What type is dislocation is most vulnerable? o Posterior Dislocation What three arteries are involved in the Cruciate Anastomosis? o Inferior Gluteal Artery o Lateral and Medial Circumflex Femoral Arteries o First Perforating Artery of the Profunda Femoris Artery What are the four muscles that flex the hip? o Iliopsoas o Pectineus o Rectus Femoris o Tensor Fascia Latae Where do the Iliacus and the Psoas Major insert? o Lesser Trochanter of the Femur What muscle is the most powerful extensor of the hip joint? o Gluteus Maximus What muscles abduct the hip? o Gluteus Medius o Gluteus Minimus o Tensor Fascia Latae o Piriformis o Obturator Internus What are the 6 Short Lateral Rotator Muscles of the Hip? o PGOGOQ o P: Piriformis o G: Superior Gemelli o O: Obturator Internus o G: Inferior Gemelli o O: Obturator Externus o Q: Quadratus Femoris Access above and below the Piriformis allows for the passage of neurovascular structures to the Gluteal Region. What structures pass through the Suprapiriform Foramen? o Superior Gluteal V.A.N. Access above and below the Piriformis allows for the passage of neurovascular structures to the Gluteal Region. What structures pass through the Infrapiriform Foramen? o Inferior Gluteal V.A.N. o Pudendal V.A.N. o Sciatic N. o Posterior Femoral Cutaneous N. What nerve roots form the Posterior Femoral Cutaneous N.? o S1, S2, S3 What nerve roots form the Superior Gluteal N.? o L4, L5, S1 What nerve roots form the Inferior Gluteal N.? o L5, S1, S2 What nerve roots form the Sciatic N.? o L4, L5, S1, S2, S3 From what Iliac Trunk does the Superior Gluteal Artery originate? o Posterior Trunk of Iliac Artery From what Iliac Trunk does the Inferior Gluteal Artery originate? o Anterior Trunk of Iliac Artery THE THIGH What is the normal Angle of Inclination of the Femur? o 125-130 degrees What is an Angle of Inclination greater than 130 degrees? o Coxa Valga What is an Angle of Inclination less than 100 degrees? o Cova Vera What is the Superficial Fascia that covers the thigh? o Cribiform Fascia What vein pierces the Fossa Ovalis of the Cribiform Fascia? o Great Saphenous Vein What are the three components of the thigh? o Anterior, Medial, Posterior What are the muscles of the Anterior Thigh? o Rectus Femoris o Vastus Medialis o Vastus Lateralis o Vastus Intermedius o Sartorius What is the nerve supply to the Anterior Thigh? o Femoral Nerve What is the blood supply to the Anterior Thigh? o Femoral Artery, Femoral Vein What is the Obliquus Genu? What muscle does the fibers come from? o Stabilizes the Patella o Fibers from the Vastus Medialis What are the muscles of the Medial Thigh? o Adductor Longus o Adductor Brevis o Adductor Magnus o Pectineus o Gracilus o Obturator Externus What is the nerve supply to the Medial Thigh? o Obturator Nerve What is the blood supply to the Medial Thigh? o Obturator What are the boundaries of the Femoral Triangle? o Inguinal Ligament o Sartorius Muscle o Adductor Longus Muscle What structures run through the Femoral Triangle? o Femoral Vein o Femoral Artery o Femoral Nerve o Great Saphenous Vein o Lymph Nodes o Fat What is the Adductor Canal? o The canal below the Sartorius Muscle o Sub-Sartorial Canal o Hunter’s Canal What is contained in the Adductor Canal? o Femoral V.A.N. o Saphenous Nerve (Longest branch of the Femoral Nerve) What are the muscles of the Posterior Thigh? o Semitendenosus o Semimembranous o Long Head of the Biceps Femoris o Short Head of the Biceps Femoris What is the nerve supply to the Posterior Compartment of the Thigh? o Tibial Nerve What is the blood supply to the Posterior Compartment of the Thigh? o Deep Femoral Artery The Short Head of the Biceps Brachii is an exception. Why? o It is innervated by the Common Fibular Nerve (not the Tibial) What is the Pes Anserinus? o Goose foot from three muscles: Semitendinosus Gracilis Sartorius Where does the Pes Anserinus insert? o Medial Aspect of the Tibia When does the Femoral Artery become the Popliteal Artery? o After it passes through the Adductor Magnus Muscle What is in the Popliteal Fossa? What is the deepest structure? o Popliteal Artery (deepest) o Popliteal Vein o Tibial Nerve o Fibular Nerve THE KNEE AND THE LEG: The Synovial Hinge Joint of the knee is composed of three Articular Surfaces. What are these? o Two Femorotibial Articulations between the Lateral and Medial Condyles o One intermediate Femoropatellar Articulation between the Patella and Femur What are the aspects of stabilization of the knee? o Muscles and their tendons Vastus Lateralis Vastus Medialis o Ligaments connecting the Femur and the Tibia How does the Popliteus Tendon pass out of the Joint Capsule? Where does it attach? o Through a hole in the Fibrous Layer of the Capsule o Attaches to Tibia The tendon of what muscle forms the superior aspect of the Joint Capsule? o Quadraceps Femoris What is the bursae of the knee that is important during extension of the leg? o Suprapatellar Bursa What are the two important ligaments of the knee joint that function in stability? o Medial Collateral (MCL) o Lateral Colateral (LCL) What type of force does the MCL and LCL protect against? o MCL: Valgus o LCL: Varus What is the function of the Medial and Lateral Menisci? o Deepen the shallow tibial articular surfaces and help to prevent sideto-side rocking of the femur on the tibia What is the difference between the Medial and Lateral Menisci? o Medial Meniscus: Oval o Lateral Meniscus: Circular Where does the Anterior Cruciate Ligament (ACL) Originate and Insert? What is its function? o Originates: Anterior Part of the Intercondylar Region o Inserts: Lateral Femoral Condyle o Function: Prevents slipping during extension of the knee Where does the Posterior Cruciate Ligament (PCL) Originate and Insert? What is its function? o Originates: Posterior Part of the Intercondylar Region o Inserts: Medial Femoral Condyle o Function: Prevents slipping of the femur towards the tibia (flexing the knee) What connects the two menisci anteriorly? o Transverse Genicular Ligament To what ligament is the Tibial Collateral Ligament attached? o Medial Miniscus What is the only muscle allowed through the joint capsule? o Popliteus Muscle What muscle is the Oblique Popliteal Ligament formed from? o Semimembranous Muscle What is the most important function of the Popliteus Muscle? o The key to unlocking the extended leg When the knee locks (when extended) what way does it slightly rotate? o Medially What does the Unhappy Triad contain? o Anterior Cruciate Ligament o Medial Meniscus o Medial (Tibial) Collateral Ligament What is significant about the Unhappy Triad? o When the knee is hit from the lateral side, usually all three ligaments tear at the same time. The Synovial Membrane extends where? o Tendon of the Quadriceps Femoris Where does the IT Band insert? o Gerdy’s Tubercle of the Tibia (lateral) What are the three compartments of the Leg? o Anterior, Posterior, and Lateral What are the muscles of the Anterior Compartment of the leg? o Tibialis Anterior M o Extensor Digitorium Longus M o Extensor Hallucis Longus o Fibularis Tertius M What is the nerve supply to the Anterior Compartment of the leg? o Deep Fibular Nerve What is the blood supply to the Anterior Compartment of the leg? o Anterior Tibial Artery What holds the Extensor Muscles against the leg? o Extensor Retinaculum Where does the Fibularis Tertius (Anterior Compartment) insert? o Only on Digit 5 What are the muscles of the Lateral Compartment of the leg? o Fibularis Longis M. o Fibularis Brevis M. What is the nerve supply to the Lateral Compartment of the leg? o Superficial Fibular Nerve What is the blood supply to the Lateral Compartment of the leg? o Fibular Artery What are the Superficial Muscles of the Posterior Compartment of the leg? o Gastrocnemius o Plantaris o Soleus What are the Deep Muscles of the Posterior Compartment of the leg? o Popliteus o Flexor Hallucis Longus M o Flexor Hallucis Digitorum M o Tibialis Posterior M What is the nerve supply to the Posterior Compartment of the leg? o Tibial Nerve What is the blood supply to the Posterior Compartment of the leg? o Posterior Tibial Artery What muscles make up the Triceps Surae? o Gastrocnemius (Medial and Lateral Head) o Soleus What is the order of structures passing into the sole of the foot around the MEDIAL Malleolus? o Tom, Dick, and Very Naughty Harry o Tibialis Posterior o Flexor Digitorum Longus M. o Posterior Tibial Artery o Posterior Tibial Vein o Tibial Nerve o Flexor Hallucis Longus M What drains the Great Saphenous Vein? o Femoral Vein What drains the Small Saphenous Vein? o Popliteal Vein Where does lymph drain from the Great Saphenous Vein? o Superficial Inguinal Lymph Nodes Where does lymph drain from the Small Saphenous Vein? o Popliteal Lymph Nodes THE FOOT AND ANKLE What three bones make up the Ankle (Talocrural) Joint? o Tibia o Fibula o Superior Talus (Trochlea) What is the name of the socket formed by the Tibia and the Fibula, where the Talus sits? o Malleolar Mortise Is the Malleolar Mortise stronger when the foot is Dorsiflexed or Plantar Flexed? o Dorsiflexed When is the ankle joint most unstable (Dorsiflexion or Plantar Flexion)? o Plantar Flexion What is the Subtalar Joint? o The joint between the Talus and the Calcaneus How is the ankle joint reinforced LATERALLY? o Lateral Ligament of the Ankle Anterior Tibiofibular Ligament Posterior Tibiofibular Ligament Calcaneofibular Ligament How is the ankle joint reinforced MEDIALLY? o Deltoid Ligament Tibionavicular Tibiacalcaneal Anterior Tibiotalar Posterior Tibiotalar What is the ligament that is most frequently torn in an Ankle Sprain? o Lateral Ligament of the Ankle: Anterior Tibiofibular Ligament*** Calcaneofibular Ligament Name the 7 Tarsal Bones. o Calcaneus o Talus o Lateral, Intermediate, Medial Cunieforms o Cuboid o Navicular What bones make up the Forefoot? o Metatarsals o Phalanges What bones make up the Midfoot? o Cunieforms o Cuboid o Navicular What bones make up the Hindfoot? o Talus o Calcaneus What are the three important ligaments that support the longitudinal arch? o Plantar Calcaneonavicular Ligament (Spring Ligament) o Long Plantar Ligament o Short Plantar Ligament What are the four compartments of the foot? o Medial Compartment (big toe) o Central Compartment o Lateral Compartment o Interosseous Compartment What are the two Intrinsic Muscles of the Dorsal Foot? o Extensor Digitorum Brevis – Intrinsic o Extensor Hallucis Brevis – Intrinsic What are the two Extrinsic Muscles of the Dorsal Foot? o Extensor Digitorum Longus o Extensor Digitorum Brevis What is the band on the Dorsal Foot that holds all of the muscles in place called? o Inferior Extensor Retinaculum What is the Plantar Aponeurosis? What arch does it support? o Thickening of deep fascia in the sole of the foot. o Longitudinal Arch What are the 3 Superficial Muscles of the Plantar Foot (Layer One)? o Flexor Digitorum Brevis M o Abductor Digiti Minimi < o Abductor Hallucis M What are the 3 Muscles of the Plantar Foot (2nd Layer)? o Lumbrical M o Flexor Digitorum Longus o Quadratus Plantae What are the 3 Muscles of the Plantar Foot (3rd Layer)? o Adductor Hallucis (Transverse and Oblique Heads) o Flexor Digiti Minimi o Flexor Hallucis Brevis (Medial and Lateral Heads) What are the muscles of the Plantar Foot (4th Layer)? o PADs – Plantar Interossei Adduct (3) o DABs – Dorsal Interossei Abduct (4) What is the keystone bone of the Medial Arch? o Head of the Talus CLINICAL COORELATIONS: What is Trendelenburg Sign? o Tests for entrapment of Superior Gluteal Nerve o If someone stands on their left leg, and their right hip drops, then the Gluteus Medius and Gluteus Minimus on their supported side is not working. What is Piriformis Syndrome? o Neuromuscular Disorder where the Sciatic Nerve is compressed/irritated by the Piriformis Muscle. o Causes pain, tingling, numbness Where do you perform an Intramuscular Injection? o Superolateral Quadrant of the Buttock What is the Alternative Site for an Intramuscular Injection? o Between Anterior Superior Iliac Spine, Tubercle of the Iliac Crest, and the Greater Trochanter What nerves are you trying to avoid when performing an Intramuscular Injection? o Superior Gluteal Nerve o Sciatic Nerve What is Meralgia Parasthetica? o Numbness and tingling of outer thigh o Compression of Lateral Cutaneous Nerve of Thigh (as it passes under Inguinal Ligament) What is Gluteal Crush Injury Compartment Syndrome? o Secondary complication following trauma o Increase in interstitial pressure due to internal bleeding. Fascia is tough and the pressure causes ischemia in the thigh muscles. What is the Galeazzi Test (Allis Sign)? o Holding infants feet against their buttocks and comparing the two knees. o If one is higher than the other, the test is positive for Congenital Hip Dislocation. What is Perthes Disease? o Deformity of the Femoral Head o Loss of blood supply due to the Cruciate Anastomoses causes the bone to stop growing, leading to a weak bone and a loss of bone mass. o Found in children. What is Osgood-Schlatter Disease (OSD)? o A painful lump just below the knee due to inflammation of the Patellar Ligament at the Tibial Tuberosity o Due to overuse What is the difference between Westphal’s Sign and Cerebellar Disease? o Westphal’s Sign: Absence or Decrease of Patella Tendon Reflex o Cerebellar Disease: Multiple oscillation of leg What is a Popliteal Artery Aneurysm? o Causes dilation of the Popliteal Artery Edema and pain in the Popliteal Fossa (back of knee) How do you bypass a Popliteal Artery Aneurysm? o Ligate the Femoral Artery using the Genicular Anastomoses o Superficial Lateral Geniculate Artery What is a Motorbike Passenger Fracture of the Femur? o Both condyles are broken using a Y or T shape What is the most common Dislocation of the Patella? o Lateral o Due to lateral tension of Iliotibial Banda and predominance of Vastus Lateralis M. What ligament does the Anterior Drawer Sign test? o ACL o Pull up on the leg What ligament does the Posterior Drawer Sign test? o PCL o Push down on the leg What is a Baker’s Cyst? o Collection of Synovial Fluid that has escaped the knee joint What is Foot Drop? o Irritation to the Common Fibular Nerve (Common Peroneal Nerve) causes the foot to drop. What are Varicose Veins caused by? o Valvular Incompetence What is Elephantiasis/Lymphedema? o Swelling of the legs when lymph isn’t flowing normally What does sensory to the medial leg? o Saphenous What does sensory to the lateral leg? o Sural What is a Pott’s Fracture? o An ankle fracture where there is forced eversion (abduction) of the foot. What ligament is affected during a Pott’s Fracture? o Deltoid What bone is fractured during a Pott’s Fracture? o The Fibula What is the Chopart’s Amputation? o Amputation made between the Calcaneus/Talus and the Cuboid/Navicular. o Only the Calcaneus and Talus are left of the foot bones. What is the Lisfranc Amputation? o Amputation made between the Cunieforms and the Metatarsals. o All bones still in tact besides the Metatarsals and the Phalanges